Provider Demographics
NPI:1689449910
Name:OPTUM BEHAVIORAL CARE OF NORTH CAROLINA, PC
Entity Type:Organization
Organization Name:OPTUM BEHAVIORAL CARE OF NORTH CAROLINA, PC
Other - Org Name:EDELSON AND ASSOCIATES OF KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-506-6267
Mailing Address - Street 1:11000 OPTUM CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-2503
Mailing Address - Country:US
Mailing Address - Phone:859-287-0760
Mailing Address - Fax:
Practice Address - Street 1:230 LEXINGTON GREEN CIR STE 420
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3337
Practice Address - Country:US
Practice Address - Phone:859-287-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty